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Emergency Care, 13e (Limmer et al.)
Chapter 23 Behavioral and Psychiatric Emergencies and Suicide
1) When a person acts in a manner that is unacceptable to himself or those around him, this
would be considered which of the following?
A) Mental illness
B) Psychotic episode
C) Behavioral emergency
D) Psychosomatic reaction
Objective: 23.1
2) Your patient is exhibiting bizarre and aggressive behavior; he starts shouting and becomes
violent. He has extra strength and appears insensitive to pain. Drug paraphernalia is visible on-
scene. This behavior is known as:
A) chemical delirium.
B) excited delirium.
C) sensory excitement.
D) intoxication reaction.
Objective: 23.1
1
3) EMTs may come across a situation where a patient begins to act extremely agitated or
psychotic. Elevated temperature and sometimes alcohol or drug intoxication may be present. The
patient will soon cease struggling, and often within minutes the patient develops inadequate or
absent respirations and subsequently dies. It is important for the EMT to be alert for this
sequence of events in a patient who exhibits this behavior and monitor the patient constantly
throughout the call. This condition is called:
A) excited or agitated delirium.
B) psychotic delirium.
C) excited psychosis.
D) bipolar disorder.
Objective: 23.1
2
4) It can sometimes be difficult to determine whether someone who is showing unusual behavior
is having a psychological emergency or is showing an altered level of consciousness due to a
physical issue. Which of the following statements are true?
1. Consider patients who are exhibiting crisis or unusual behavior to be having an altered mental
status from a nonpsychiatric cause until proven otherwise.
2. Many medical and traumatic conditions are likely to alter a patient's behavior.
3. Lack of oxygen may cause restlessness and confusion, cyanosis (blue or gray skin), and
altered mental status.
4. Stroke or inadequate blood to the brain may cause confusion or dizziness and what appears to
be erratic behavior.
A) 1, 2
B) 1, 2, 3
C) 1, 3, 4
D) 1, 2, 3, 4
Objective: 23.2
5) When a patient or bystander at the scene of an emergency displays fear, anger, or grief, this is
best described as which of the following?
A) Neurosis
B) Stress reaction
C) Post-traumatic stress disorder
D) Catharsis
Objective: 23.2
3
6) Which one of the following statements is NOT true?
A) In any given year, 26.2% of adult Americans suffer from a diagnosable mental disorder.
B) Almost 10% of the population of adult Americans has a mood disorder such as depression.
C) Just over 20% of the population of adult Americans has anxiety or panic issues.
D) It is very unusual for an EMT to be called for a psychiatric emergency.
Objective: 23.2
7) Which of the following statements concerning behavioral emergencies is true?
A) Emotional outbursts are considered behavioral emergencies.
B) The person with a behavioral emergency requires prolonged institutionalization.
C) A person with a behavioral emergency is mentally ill.
D) It may be difficult to determine what behavior is abnormal for a given person in a given
situation.
Objective: 23.2
4
8) According to coworkers, your 25-year-old female patient suddenly began acting aggressively
and being verbally abusive. She tells you she is "starving" and you notice that she is pale and
diaphoretic. Which of the following would be an appropriate general impression?
A) Alcoholic intoxication
B) An underlying physical illness
C) Sudden onset of schizophrenia
D) Alcohol withdrawal
Objective: 23.3
9) Which of the following may cause a patient to exhibit abnormal behavior?
A) Hypoxia
B) Allergic reaction
C) Gastroenteritis
D) Snakebites
Objective: 23.3
5
10) Which of the following statements regarding behavioral emergencies is NOT true?
A) Patients experiencing a behavioral emergency are not always dangerous to themselves or
others.
B) It would be unusual to find a person with schizophrenia outside a mental health facility.
C) Differences in culture may initially appear to be abnormal behaviors to the EMT.
D) Apparent behavioral emergencies may be due to an underlying medical cause.
Objective: 23.3
11) Which of the following medical conditions may be the underlying cause of an apparent
behavioral emergency?
A) Mental illness
B) Stroke
C) Hypoglycemia
D) All of the above
Objective: 23.3
6
12) Which of the following traumatic conditions may account for signs and symptoms of a
behavioral emergency?
A) Fractured lumbar vertebra
B) 10% BSA partial thickness burn
C) Fractured tibia
D) Internal hemorrhage
Objective: 23.3
13) Which of the following findings would be helpful in differentiating between a closed head
injury and a behavioral emergency?
A) Irrational behavior
B) Unequal pupils
C) Confusion
D) Combativeness
Objective: 23.3
7
14) It is often difficult to distinguish a true medical emergency from a psychiatric emergency.
You are confronted with a patient experiencing personality changes ranging from irritability to
irrational behavior, altered mental status, amnesia or confusion, irregular respirations, elevated
blood pressure, and decreasing pulse. It appears to be a psychiatric emergency. What else could
also likely cause this behavior?
A) Low blood sugar
B) Head injury
C) Lack of oxygen
D) Stroke
Objective: 23.3
15) Which of the following actions is the MOST appropriate for the EMT to take when managing
a patient with a behavioral emergency?
A) Find out if the patient's insurance covers psychiatric treatment.
B) Remain calm and reassure the patient.
C) Establish control of the situation by a show of force.
D) Quickly perform a head-to-toe exam and transport without delay.
Objective: 23.4
8
16) When managing a patient who may hurt himself or others, you should do all of the following
except:
A) make sure only you and the patient are in the room.
B) keep bystanders a safe distance away.
C) watch for sudden changes in the patient's behavior.
D) retreat if the patient becomes threatening.
Objective: 23.4
17) Which of the following communication strategies should be used in dealing with a patient
with a behavioral emergency?
A) Stay 2 to 3 inches from the patient at all times to make him feel secure.
B) Interrupt the patient if he appears to be going off on a tangent about something not concerning
the immediate situation.
C) Show deep sympathy for the patient's predicament and let him know he can't control the
things that are happening to him.
D) Acknowledge the patient's feelings
Objective: 23.4
9
18) Which of the following is acceptable when managing the patient with a behavioral or
psychiatric emergency?
A) Make supportive statements such as, "That must have been very hard for you."
B) Sit as close to the patient as you can to reassure him that you will not abandon him.
C) Allow family members to confront the patient about his behavior.
D) Go along with the patient's hallucinations or false beliefs.
Objective: 23.4
19) When dealing with a psychiatric emergency, which one of the following would generally be
inappropriate behavior on your part?
A) Be as hurried as you can. It is extremely important to resolve the call and get the patient to the
hospital as soon as possible.
B) Act in a calm manner, giving the patient time to gain control of his emotions.
C) Let the patient know that you are listening to what he is saying, and explain things to the
patient honestly.
D) Stay alert for sudden changes in behavior.
Objective: 23.4
10
